Percutaneous fixation of proximal fifth metatarsal fractures

Fractures of the proximal fifth metatarsal can be divided into three general patterns: avulsion of the tuberosity (type 1), Jones fractures (type 2), and diaphyseal stress fractures (type 3) [1]. Tuberosity fractures can be extra-articular or may involve the metatarsocuboid joint (Fig. 1). Jones fractures involve the metaphyseal-diaphyseal junction and extend transversely and medially into the four to five intermetatarsal joint (Figs. 1 and 2). Unlike tuberosity fractures, which reliably heal, Jones fractures have a nonunion rate between 7 % and 28 % [2, 3]. In addition, one third of Jones fractures treated conservatively may go on to closed refracture [1]. Diaphyseal stress fractures occur distal to the four to five intermetatarsal joint (Fig. 1) and are usually associated with prodromal symptoms. Torg [2] divides diaphyseal stress fractures into three types: acute fractures with sharp margins, delayed unions with a widened fracture line and intramedullary sclerosis, and established nonunions with complete obliteration of the canal.

Duke Scholars

Author James Albert Nunley II Orthopaedic Surgery